理解临床血流动力学（双语）课件_1.ppt

Chicago, Illinois 理解临床血流动力学 understanding clinicial hemodynamics 原文：Micharel F. O’Connor, M.D. FCCM 翻译：福建医科大学附属协和医院麻醉科规培住院医师 陈静 The physiologic paradigm that clinicians reference in their attempts to explain and understand the biology of both healthy and critically ill patients has been in evolution for more than 100 years. （临床医师尝试着阐述和了解健康和危重症患者而借助的生理学范式已经发展100多年了。） Interestingly, our understanding of the clinical circulation has always been thought of as ‘complete’, （有趣的是，人们对临床循环的理解一直被视为“很完整”，） with creative clinicians invoking a variety of reasons to explain away apparent discrepancies between commonly used mental models and the realities of clinical medicine. （而富有创新性的临床医师则希望通过种种解释消除常用思维模式和临床医学现实之间显著的差异。） The most primitive formulation of the circulation entails simple conservation of matter: （最原始的循环公式蕴含着简单的物质守恒：） Cardiac Output = Stroke Volume x Heart Rate = Qt = SV x HR （心输出量（CO）=每博量×心率=Qt = SV×HR） This statement, while obviously always true, offers sapient practitioners little insight into why the circulation in a articular patient might be unacceptable, and how they might rationally intervene. （很显然，该表述很正确，却几乎没有为智慧的工作者深入了解为何个别患者的循环可能不稳定以及如何进行合理的干预提供帮助。） During the mid-20th century, a relatively complete paradigm for understanding the role of the enous return in controlling the cardiac output was refined by Guyton and his co-workers, and has been repetitively validated since it was first described (refs Jacobsohn, Magder, Guyton, Sylvester). 在20世纪中叶，Guyton及其同事修订了一个相对完善、关于了解静脉回心血量在控制心输出量中的作用的范式，该范式从首次被描述就进行了反复验证。 Although not complete, this theory was powerful in the hands of those who understood it. 尽管该理论还不完善，却对已理解该理论的人群产生了很大的作用。 The balloon-tipped, flow directed, thermistor equipped pulmonary artery catheter heralded the subsequent era of the understanding of the clinical circulation. 装备有末端套囊、血流导向以及热敏电阻的肺动脉导管，预示着理解临床循环时代的到来。 This device, coupled with a deep understanding of the mechanics of left ventricular function her